Provider Demographics
NPI:1871558866
Name:WEEKS, THERESA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:WEEKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:M
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4450 CARVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5527
Mailing Address - Country:US
Mailing Address - Phone:513-508-2628
Mailing Address - Fax:513-984-9858
Practice Address - Street 1:4450 CARVER WOODS DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5527
Practice Address - Country:US
Practice Address - Phone:513-508-2628
Practice Address - Fax:513-508-2628
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6838103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30607030Medicaid
KY30607030Medicaid
610661458OtherFEDERAL TAX ID NUMBER
P92780Medicare UPIN